In recent years, the effectiveness of flow diverters (FDs) for the treatment of intracranial aneurysms has been reported. While FDs are effective, their deployment involves advancing a delivery wire distally, which may pose a risk if a distal aneurysm exists within the same artery. In such cases, the delivery wire could potentially perforate the distal aneurysm. Here, we present two cases of tandem aneurysms in which an internal carotid artery (ICA) aneurysm was treated with an FD following the treatment of a distal cerebral aneurysm.
Case description
A 44-year-old woman and a 67-year-old woman underwent magnetic resonance imaging for headache or abducens nerve palsy. In both cases, two aneurysms were revealed: one at the ICA and the other either at the middle cerebral artery or the top of the ICA. Due to the risk of perforation by the delivery wire during FD deployment, the distal aneurysms were treated first—either with surgical neck clipping or stent-assisted coil embolization. One month after the initial treatment, FD placement for the ICA aneurysm was performed as planned without complications in either case.
Discussion
This is the first report where tandem aneurysms were successfully treated with treatment for distal cerebral aneurysms, followed by FDs for proximal ICA aneurysms. We emphasize the potential risk of perforation of the distal aneurysm by the delivery wire during FD placement.
Conclusion
Treatment of distal cerebral aneurysms beforehand can help ensure the safe and effective use of FDs in patients with tandem aneurysms.
{"title":"Flow diverter treatment for internal carotid artery aneurysm following management of distal cerebral aneurysms: Technical note","authors":"Yuichi Hirata , Masafumi Hiramatsu , Kenji Sugiu , Fukiko Baba , Juntaro Fujita , Yuta Sotome , Masato Kawakami , Ryu Kimura , Yuki Ebisudani , Jun Haruma , Tomohito Hishikawa , Shota Tanaka","doi":"10.1016/j.wnsx.2025.100540","DOIUrl":"10.1016/j.wnsx.2025.100540","url":null,"abstract":"<div><h3>Background</h3><div>In recent years, the effectiveness of flow diverters (FDs) for the treatment of intracranial aneurysms has been reported. While FDs are effective, their deployment involves advancing a delivery wire distally, which may pose a risk if a distal aneurysm exists within the same artery. In such cases, the delivery wire could potentially perforate the distal aneurysm. Here, we present two cases of tandem aneurysms in which an internal carotid artery (ICA) aneurysm was treated with an FD following the treatment of a distal cerebral aneurysm.</div></div><div><h3>Case description</h3><div>A 44-year-old woman and a 67-year-old woman underwent magnetic resonance imaging for headache or abducens nerve palsy. In both cases, two aneurysms were revealed: one at the ICA and the other either at the middle cerebral artery or the top of the ICA. Due to the risk of perforation by the delivery wire during FD deployment, the distal aneurysms were treated first—either with surgical neck clipping or stent-assisted coil embolization. One month after the initial treatment, FD placement for the ICA aneurysm was performed as planned without complications in either case.</div></div><div><h3>Discussion</h3><div>This is the first report where tandem aneurysms were successfully treated with treatment for distal cerebral aneurysms, followed by FDs for proximal ICA aneurysms. We emphasize the potential risk of perforation of the distal aneurysm by the delivery wire during FD placement.</div></div><div><h3>Conclusion</h3><div>Treatment of distal cerebral aneurysms beforehand can help ensure the safe and effective use of FDs in patients with tandem aneurysms.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100540"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Complex, unclippable aneurysms of the pre-bifurcation segment of the M1 middle cerebral artery (pre-bM1) are rare and challenging to treat due to their association with lenticulostriate arteries (LSAs), particularly in ruptured cases. This study evaluates the outcomes and complications of microsurgical treatment employing distal occlusion and revascularization.
Methods
Eight patients with ruptured unclippable pre-bM1 aneurysms treated via distal occlusion and revascularization between 2018 and 2024 were retrospectively analyzed for radiographic and clinical outcomes.
Results
Complete aneurysm obliteration was achieved in all patients, with seven (87.5 %) out of eight patients attaining this within 7 days post-surgery. No postoperative rebleeding occurred, and all bypass grafts remained patent. Early postoperative LSA infarctions were detected in five patients (62.5 %), with only one (12.5 %) patient experiencing early worsening of hemiparesis. At discharge, good outcomes were observed in five (5/8: 62.5 %) patients overall and four patients (4/4: 100 %) of those with good preoperative grades.
Conclusions
Distal occlusion and revascularization proved safe and effective for treating ruptured unclippable M1 aneurysms. The procedure achieved high rates of aneurysm thrombosis with minimal symptomatic complications. Postoperative LSA infarction was the primary complication, although most cases were asymptomatic. Further refinement of microsurgical techniques is warranted to reduce this complication.
{"title":"Distal occlusion and revascularization for microsurgical treatment of ruptured unclippable M1 segment middle cerebral artery aneurysms: Surgical outcomes and complications","authors":"Nasaeng Akharathammachote, Kitiporn Sriamornrattanakul, Chanon Ariyaprakai, Atithep Mongkolratnan","doi":"10.1016/j.wnsx.2025.100549","DOIUrl":"10.1016/j.wnsx.2025.100549","url":null,"abstract":"<div><h3>Background</h3><div>Complex, unclippable aneurysms of the pre-bifurcation segment of the M1 middle cerebral artery (pre-bM1) are rare and challenging to treat due to their association with lenticulostriate arteries (LSAs), particularly in ruptured cases. This study evaluates the outcomes and complications of microsurgical treatment employing distal occlusion and revascularization.</div></div><div><h3>Methods</h3><div>Eight patients with ruptured unclippable pre-bM1 aneurysms treated via distal occlusion and revascularization between 2018 and 2024 were retrospectively analyzed for radiographic and clinical outcomes.</div></div><div><h3>Results</h3><div>Complete aneurysm obliteration was achieved in all patients, with seven (87.5 %) out of eight patients attaining this within 7 days post-surgery. No postoperative rebleeding occurred, and all bypass grafts remained patent. Early postoperative LSA infarctions were detected in five patients (62.5 %), with only one (12.5 %) patient experiencing early worsening of hemiparesis. At discharge, good outcomes were observed in five (5/8: 62.5 %) patients overall and four patients (4/4: 100 %) of those with good preoperative grades.</div></div><div><h3>Conclusions</h3><div>Distal occlusion and revascularization proved safe and effective for treating ruptured unclippable M1 aneurysms. The procedure achieved high rates of aneurysm thrombosis with minimal symptomatic complications. Postoperative LSA infarction was the primary complication, although most cases were asymptomatic. Further refinement of microsurgical techniques is warranted to reduce this complication.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100549"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the predictive value of spinopelvic parameters and clinical variables for recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).
Methods
We retrospectively collected data from 1219 patients who underwent PELD surgery between January 2017 and January 2023, randomly divided into training (70 %) and validation (30 %) groups. Univariate and multivariate logistic regression analyses were performed in the training set to identify independent risk factors and construct a nomogram model. Model accuracy was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was evaluated through calibration curves and goodness-of-fit tests. Decision curve analysis (DCA) was performed to assess net clinical benefit.
Results
Multivariate analysis identified BMI ≥25 kg/m2, high-intensity labor, pelvic incidence (PI) <45° or >60°, sacral slope (SS) < 35°, Pfirrmann grade III, and Modic type II and III changes as independent predictors of rLDH (p < 0.05). The model achieved an AUC of 0.836 (95 %CI: 0.801–0.872) in the training set and 0.812 (95 %CI: 0.735–0.888) in the validation set. Calibration curves showed good agreement between predicted and observed values. DCA demonstrated that the model provided significant net clinical benefit when intervention threshold probabilities were set at 2 %–59 % for the training set and 2 %–45 % for the validation set.
Conclusion
The spinopelvic parameter-based nomogram prediction model demonstrated excellent predictive performance for rLDH after PELD and facilitates individualized risk assessment.
{"title":"Development and validation of a nomogram model based on spinopelvic parameters for predicting recurrent lumbar disc herniation","authors":"Tengyu Wang, Conggang Liao, Yufei Jin, Keyu Luo, Xiang Yin","doi":"10.1016/j.wnsx.2025.100545","DOIUrl":"10.1016/j.wnsx.2025.100545","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the predictive value of spinopelvic parameters and clinical variables for recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).</div></div><div><h3>Methods</h3><div>We retrospectively collected data from 1219 patients who underwent PELD surgery between January 2017 and January 2023, randomly divided into training (70 %) and validation (30 %) groups. Univariate and multivariate logistic regression analyses were performed in the training set to identify independent risk factors and construct a nomogram model. Model accuracy was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was evaluated through calibration curves and goodness-of-fit tests. Decision curve analysis (DCA) was performed to assess net clinical benefit.</div></div><div><h3>Results</h3><div>Multivariate analysis identified BMI ≥25 kg/m<sup>2</sup>, high-intensity labor, pelvic incidence (PI) <45° or >60°, sacral slope (SS) < 35°, Pfirrmann grade III, and Modic type II and III changes as independent predictors of rLDH (<em>p</em> < 0.05). The model achieved an AUC of 0.836 (95 %CI: 0.801–0.872) in the training set and 0.812 (95 %CI: 0.735–0.888) in the validation set. Calibration curves showed good agreement between predicted and observed values. DCA demonstrated that the model provided significant net clinical benefit when intervention threshold probabilities were set at 2 %–59 % for the training set and 2 %–45 % for the validation set.</div></div><div><h3>Conclusion</h3><div>The spinopelvic parameter-based nomogram prediction model demonstrated excellent predictive performance for rLDH after PELD and facilitates individualized risk assessment.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100545"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100541
Muhammad Izhar , Yusuke S. Hori , Ahed H. Kattaa , Fred C. Lam , Neeraj Kalra , Nirmeen Zagzoog , Armine Tayag , Louisa Ustrzynski , Sara C. Emrich , Erqi L. Pollom , Scott G. Soltys , Melanie Hayden Gephart , David J. Park , Steven D. Chang
<div><h3>Background</h3><div>Brain metastases (BM) from hepatocellular carcinoma (HCC) are rare and typically associated with poor prognosis. While whole-brain radiotherapy (WBRT) and surgical resection have been used for treatment, their applicability is often limited due to hepatic dysfunction and associated comorbidities. Stereotactic radiosurgery (SRS) offers a less invasive, targeted approach, but its role in HCC-related BM, especially in the context of hepatitis C virus (HCV) infection, remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated patients with BM secondary to HCV-related HCC who were treated with SRS. Treatment parameters, including prescribed radiation dose, local tumor control (LTC), radiological response, and overall survival (OS), were assessed. Tumor control was defined based on radiological response to CyberKnife (CK) SRS as a complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) per response evaluation criteria in solid tumors (RECIST) guidelines. Moreover, we conducted a systematic review in accordance with PRISMA using three databases: PubMed/MEDLINE, Embase, and Web of Science.</div></div><div><h3>Results</h3><div>This is the first study to report outcomes of SRS specifically in patients with BM from HCV-related HCC. A total of 3 patients with a total number of 7 lesions were treated with a median prescribed dose of 27 Gy (range: 20–30 Gy). All treated lesions achieved 100 % LTC at 3-month, 6-month, and final follow-up evaluations, with no evidence of local progression. Radiologic assessment showed complete response in 14.3 % of lesions, partial response in 28.6 %, and stable disease in 57.1 %, with no cases of progressive disease. The mean overall survival was 8 months, falling within the upper range of previously reported survival (4–20 weeks) in HCC BM patient populations. For the systematic review, a total of 98 studies were initially identified through database searches. Following the removal of 8 duplicate entries, 90 studies were screened by title and abstract, resulting in 9 studies for full-text assessment. Of these, 3 were excluded for not meeting the inclusion criteria. Ultimately, 6 studies were included in the final systematic review. According to the systematic review, treatment was most commonly performed with Gamma Knife radiosurgery, with marginal doses ranging from 10 to 32 Gy delivered at the 50 % isodose line. Tumor volumes varied significantly (0.01–67.3 cm<sup>3</sup>), and hemorrhagic presentation was frequent, occurring in up to 76 % of cases. Reported overall survival (OS) ranged from 2 to 47 weeks. SRS-related complications were generally minimal. However, the existing literature is limited by heterogeneity and inconsistent evaluation of key prognostic factors.</div></div><div><h3>Conclusion</h3><div>SRS is a safe and effective treatment for BM in patients with HCV-related HCC, offering excellent local control. Given the rar
肝细胞癌（HCC）的脑转移（BM）是罕见的，通常与预后不良有关。虽然全脑放疗（WBRT）和手术切除已被用于治疗，但由于肝功能障碍和相关合并症，其适用性往往受到限制。立体定向放射外科（SRS）提供了一种侵入性较小的靶向治疗方法，但其在丙型肝炎病毒（HCV）感染的丙型肝炎相关脑转移中的作用尚不清楚。方法回顾性评价接受SRS治疗的hcv相关性HCC继发BM患者。评估治疗参数，包括规定的放射剂量、局部肿瘤控制（LTC）、放射反应和总生存期（OS）。肿瘤控制根据射波刀（CK） SRS的放射学反应定义为完全缓解（CR），部分缓解（PR），疾病稳定（SD）和疾病进展（PD），根据实体瘤反应评价标准（RECIST）指南。此外，我们根据PRISMA使用PubMed/MEDLINE、Embase和Web of Science三个数据库进行了系统评价。这是第一个报道SRS治疗hcv相关HCC患者预后的研究。共有3例患者，共7个病灶，中位处方剂量为27 Gy（范围：20-30 Gy）。所有接受治疗的病变在3个月、6个月和最终随访评估时均达到100% LTC，无局部进展迹象。放射学评估显示14.3%的病变完全缓解，28.6%的病变部分缓解，57.1%的病变稳定，无进展病例。平均总生存期为8个月，处于先前报道的HCC脑转移患者群体生存期（4-20周）的上限范围内。在系统评价中，通过数据库搜索初步确定了总共98项研究。在删除8个重复条目后，根据标题和摘要筛选了90项研究，其中9项研究进行了全文评估。其中3例因不符合纳入标准而被排除。最终，6项研究被纳入最终的系统评价。根据系统评价，治疗最常用的是伽玛刀放射手术，边际剂量范围为10至32 Gy，以50%等剂量线递送。肿瘤体积差异显著（0.01-67.3 cm3），出血表现频繁，高达76%的病例发生。报告的总生存期（OS）为2至47周。srs相关并发症一般很少。然而，现有文献受到异质性和关键预后因素评估不一致的限制。结论srs是一种安全有效的治疗乙型肝炎相关HCC患者脑转移的方法，具有良好的局部控制性。鉴于这种情况的罕见性和较小的队列规模，我们的研究结果的普遍性是有限的；因此，需要更大规模的前瞻性研究来证实这些结果，并探讨肿瘤病因对治疗结果的影响。此外，需要在未来的研究中标准化报告，以解决当前文献中潜在的异质性和差距。
{"title":"Stereotactic radiosurgery for hepatitis C virus-related hepatocellular carcinoma brain metastasis: A retrospective analysis and systematic review","authors":"Muhammad Izhar , Yusuke S. Hori , Ahed H. Kattaa , Fred C. Lam , Neeraj Kalra , Nirmeen Zagzoog , Armine Tayag , Louisa Ustrzynski , Sara C. Emrich , Erqi L. Pollom , Scott G. Soltys , Melanie Hayden Gephart , David J. Park , Steven D. Chang","doi":"10.1016/j.wnsx.2025.100541","DOIUrl":"10.1016/j.wnsx.2025.100541","url":null,"abstract":"<div><h3>Background</h3><div>Brain metastases (BM) from hepatocellular carcinoma (HCC) are rare and typically associated with poor prognosis. While whole-brain radiotherapy (WBRT) and surgical resection have been used for treatment, their applicability is often limited due to hepatic dysfunction and associated comorbidities. Stereotactic radiosurgery (SRS) offers a less invasive, targeted approach, but its role in HCC-related BM, especially in the context of hepatitis C virus (HCV) infection, remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated patients with BM secondary to HCV-related HCC who were treated with SRS. Treatment parameters, including prescribed radiation dose, local tumor control (LTC), radiological response, and overall survival (OS), were assessed. Tumor control was defined based on radiological response to CyberKnife (CK) SRS as a complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) per response evaluation criteria in solid tumors (RECIST) guidelines. Moreover, we conducted a systematic review in accordance with PRISMA using three databases: PubMed/MEDLINE, Embase, and Web of Science.</div></div><div><h3>Results</h3><div>This is the first study to report outcomes of SRS specifically in patients with BM from HCV-related HCC. A total of 3 patients with a total number of 7 lesions were treated with a median prescribed dose of 27 Gy (range: 20–30 Gy). All treated lesions achieved 100 % LTC at 3-month, 6-month, and final follow-up evaluations, with no evidence of local progression. Radiologic assessment showed complete response in 14.3 % of lesions, partial response in 28.6 %, and stable disease in 57.1 %, with no cases of progressive disease. The mean overall survival was 8 months, falling within the upper range of previously reported survival (4–20 weeks) in HCC BM patient populations. For the systematic review, a total of 98 studies were initially identified through database searches. Following the removal of 8 duplicate entries, 90 studies were screened by title and abstract, resulting in 9 studies for full-text assessment. Of these, 3 were excluded for not meeting the inclusion criteria. Ultimately, 6 studies were included in the final systematic review. According to the systematic review, treatment was most commonly performed with Gamma Knife radiosurgery, with marginal doses ranging from 10 to 32 Gy delivered at the 50 % isodose line. Tumor volumes varied significantly (0.01–67.3 cm<sup>3</sup>), and hemorrhagic presentation was frequent, occurring in up to 76 % of cases. Reported overall survival (OS) ranged from 2 to 47 weeks. SRS-related complications were generally minimal. However, the existing literature is limited by heterogeneity and inconsistent evaluation of key prognostic factors.</div></div><div><h3>Conclusion</h3><div>SRS is a safe and effective treatment for BM in patients with HCV-related HCC, offering excellent local control. Given the rar","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100541"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100532
Ryan D. Alghamdi , Albandari S. Baatiyah , Ahmed Z. Awan , Fawaz M. Alhalafi , Aroob A. Jaad , Abdulaziz A. Alzahrani , Rakan Farouk Y. Bokhari , Abdulrahman J. Sabbagh
Background
Patients’ choices in selecting healthcare providers are increasingly complex, shaped by privatization, autonomy, and online resources. Physician-rating sites and social media let patients compare providers using reviews. Understanding determinants in Saudi Arabia can align care with expectations and improve outcomes. This study examined key factors shaping physician selection.
Methods
A cross-sectional survey was conducted using a validated 36-item questionnaire distributed online. Adults aged ≥18 years who had searched for a physician or undergone surgery were eligible. Responses on physician selection factors were rated using a Likert scale. Data were analyzed using SPSS with non-parametric tests to identify key determinants of physician choice.
Results
The study included participants aged 18–71 years (mean age 29.35), predominantly female (58.9 %) and of Saudi nationality (89.7 %). The most critical factors were the physician's experience and medical knowledge (83.3 %) and recommendations from other physicians and patients (79.1 %). Only 15 % considered a physician's social media presence essential. While 56 % sought physicians through relatives or friends, 22.4 % used the internet, primarily Google (51.6 %) and Twitter (31.2 %). Participants valued surgical outcomes (82.6 %) and academic qualifications (73.0 %) the most. Discomfort with sharing personal medical information on social media was highest among those undergoing elective surgery (p = 0.007).
Conclusion
Patients in Saudi Arabia prioritize physicians’ experience and qualifications, relying heavily on personal recommendations over social media presence. These findings highlight the importance of professional expertise and trusted networks in healthcare provider selection.
{"title":"Determinant of choice of health care providers among the general population, a cross-sectional study from Saudi Arabia","authors":"Ryan D. Alghamdi , Albandari S. Baatiyah , Ahmed Z. Awan , Fawaz M. Alhalafi , Aroob A. Jaad , Abdulaziz A. Alzahrani , Rakan Farouk Y. Bokhari , Abdulrahman J. Sabbagh","doi":"10.1016/j.wnsx.2025.100532","DOIUrl":"10.1016/j.wnsx.2025.100532","url":null,"abstract":"<div><h3>Background</h3><div>Patients’ choices in selecting healthcare providers are increasingly complex, shaped by privatization, autonomy, and online resources. Physician-rating sites and social media let patients compare providers using reviews. Understanding determinants in Saudi Arabia can align care with expectations and improve outcomes. This study examined key factors shaping physician selection.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted using a validated 36-item questionnaire distributed online. Adults aged ≥18 years who had searched for a physician or undergone surgery were eligible. Responses on physician selection factors were rated using a Likert scale. Data were analyzed using SPSS with non-parametric tests to identify key determinants of physician choice.</div></div><div><h3>Results</h3><div>The study included participants aged 18–71 years (mean age 29.35), predominantly female (58.9 %) and of Saudi nationality (89.7 %). The most critical factors were the physician's experience and medical knowledge (83.3 %) and recommendations from other physicians and patients (79.1 %). Only 15 % considered a physician's social media presence essential. While 56 % sought physicians through relatives or friends, 22.4 % used the internet, primarily Google (51.6 %) and Twitter (31.2 %). Participants valued surgical outcomes (82.6 %) and academic qualifications (73.0 %) the most. Discomfort with sharing personal medical information on social media was highest among those undergoing elective surgery (<em>p</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>Patients in Saudi Arabia prioritize physicians’ experience and qualifications, relying heavily on personal recommendations over social media presence. These findings highlight the importance of professional expertise and trusted networks in healthcare provider selection.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100532"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100529
Huan Liu , Ying-Jie Li , Li-Jun Jia , Li-Rong Wang , Sen Zhou , Hao Tao , Yi Li , Bing-Hu Li , Neng-Wei Yu
Background and purpose
Futile recanalization (FR) occurs in patients who achieve successful vessel recanalization but still have a poor prognosis. The aim of this study was to explore the association between systemic immune-inflammation index (SII) and futile recanalization following mechanical thrombectomy (MT) in acute ischemic stroke (AIS).
Methods
We retrospectively analyzed patients with AIS due to large vessel occlusion in the anterior circulation who achieved successful recanalization after MT. The SII was calculated as platelet count × neutrophil count/lymphocyte count from preoperative peripheral venous blood. FR was defined as a modified Rankin Scale (mRS) score of ≥3 at 3 months despite successful recanalization. Binary logistic regression was performed to identify independent predictors of FR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of identified factors for FR.
Results
We retrospectively analyzed 262 patients, with the median age of 70 (58.75–78.00) years. The SII in the FR group was significantly higher than in the non-FR group. After adjusting for confounding factors, binary logistic regression analysis indicated that SII was an independent predictor for FR (OR = 1.999, 95% CI: 1.324–3.018, p < 0.001). The ROC curve showed that SII can effectively predict adverse outcomes 3 months after MT [area under the curve (AUC) value: 0.687, p < 0.001], and can help the comprehensive model better predict FR (AUC value: 0.807 versus 0.772).
Conclusions
A high preoperative SII may be associated with FR in anterior circulation AIS patients with mechanical thrombectomy.
{"title":"The predictive role of systemic immune-inflammation index on futile recanalization in acute ischemic stroke with mechanical thrombectomy","authors":"Huan Liu , Ying-Jie Li , Li-Jun Jia , Li-Rong Wang , Sen Zhou , Hao Tao , Yi Li , Bing-Hu Li , Neng-Wei Yu","doi":"10.1016/j.wnsx.2025.100529","DOIUrl":"10.1016/j.wnsx.2025.100529","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Futile recanalization (FR) occurs in patients who achieve successful vessel recanalization but still have a poor prognosis. The aim of this study was to explore the association between systemic immune-inflammation index (SII) and futile recanalization following mechanical thrombectomy (MT) in acute ischemic stroke (AIS).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with AIS due to large vessel occlusion in the anterior circulation who achieved successful recanalization after MT. The SII was calculated as platelet count × neutrophil count/lymphocyte count from preoperative peripheral venous blood. FR was defined as a modified Rankin Scale (mRS) score of ≥3 at 3 months despite successful recanalization. Binary logistic regression was performed to identify independent predictors of FR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of identified factors for FR.</div></div><div><h3>Results</h3><div>We retrospectively analyzed 262 patients, with the median age of 70 (58.75–78.00) years. The SII in the FR group was significantly higher than in the non-FR group. After adjusting for confounding factors, binary logistic regression analysis indicated that SII was an independent predictor for FR (OR = 1.999, 95% CI: 1.324–3.018, <em>p</em> < 0.001). The ROC curve showed that SII can effectively predict adverse outcomes 3 months after MT [area under the curve (AUC) value: 0.687, <em>p</em> < 0.001], and can help the comprehensive model better predict FR (AUC value: 0.807 versus 0.772).</div></div><div><h3>Conclusions</h3><div>A high preoperative SII may be associated with FR in anterior circulation AIS patients with mechanical thrombectomy.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100529"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100543
Hu Chen , Lu Cao , Yinghua He , Hao Sun , Qiang Tu
Objective
The majority of previously published cervical spine models used in finite element (FE) analysis usually include only parts of motion units, resulting in differences in the realistic response of the whole cervical spine. This study aimed to develop a geometrically accurate, comprehensive, three-dimensional (3D) FE model for the entire cervical spine.
Methods
A 3D FE model of the full cervical spine was constructed based on CT data. The predicted range of motion (ROM) for each segmental motion of the cervical spine was compared with previous research. Additionally, the present FE model was used to evaluate von Mises stress in the bones, intervertebral disc pressure (IDP), and facet joint force to analyze the biomechanical effects under physiological loading.
Results
The complete FE model consisted of 2,218,790 elements and 3,332,459 nodes, including 7 cervical vertebrae, occiput, 5 intervertebral discs, 13 ligaments, and 7 pairs of facet joints. The ROMs obtained were consistent with published experiments in terms of both value and tendency. The IDP and facet joint force was asymmetric under flexion-extension, while symmetric under axial rotation and lateral bending.
Conclusion
The validation of our developed model coincided with experimental studies and proved to be more convincing than models that only considered parts of motion units.
{"title":"Development of a CT-based 3D finite element model of the whole cervical spine with occiput: Insights into sagittal balance, disc pressure, and facet joint forces","authors":"Hu Chen , Lu Cao , Yinghua He , Hao Sun , Qiang Tu","doi":"10.1016/j.wnsx.2025.100543","DOIUrl":"10.1016/j.wnsx.2025.100543","url":null,"abstract":"<div><h3>Objective</h3><div>The majority of previously published cervical spine models used in finite element (FE) analysis usually include only parts of motion units, resulting in differences in the realistic response of the whole cervical spine. This study aimed to develop a geometrically accurate, comprehensive, three-dimensional (3D) FE model for the entire cervical spine.</div></div><div><h3>Methods</h3><div>A 3D FE model of the full cervical spine was constructed based on CT data. The predicted range of motion (ROM) for each segmental motion of the cervical spine was compared with previous research. Additionally, the present FE model was used to evaluate von Mises stress in the bones, intervertebral disc pressure (IDP), and facet joint force to analyze the biomechanical effects under physiological loading.</div></div><div><h3>Results</h3><div>The complete FE model consisted of 2,218,790 elements and 3,332,459 nodes, including 7 cervical vertebrae, occiput, 5 intervertebral discs, 13 ligaments, and 7 pairs of facet joints. The ROMs obtained were consistent with published experiments in terms of both value and tendency. The IDP and facet joint force was asymmetric under flexion-extension, while symmetric under axial rotation and lateral bending.</div></div><div><h3>Conclusion</h3><div>The validation of our developed model coincided with experimental studies and proved to be more convincing than models that only considered parts of motion units.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100543"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100546
Nikhil Adapa , Andrew J. Rosso , Sandra M. Catanzaro , Emma C. Smith , W. Jacob Lavelle , Elizabeth A. Demers Lavelle , Richard A. Tallarico , Willam F. Lavelle
Background
Data: Intraoperative neuromonitoring changes of somatosensory evoked potentials (SSEPs) may portend postoperative neurological deficits. We assessed the predictive power of SSEP changes during lumbar spinal surgery for postoperative neurological deficits and recovery rates.
Methods
In a retrospective multi-surgeon review of neuromonitoring logs, we identified all lumbar spine surgery patients (2011–2021) from our institution. We collected demographic, clinical, surgical and follow-up data on only subjects with intraoperative SSEP changes categorizing them into Group A (intraoperative SSEP changes without postoperative neurological deficits) and Group B (intraoperative SSEP changes with postoperative neurological deficits) for statistical analysis.
Results
2398 subjects underwent lumbar spine surgery. 37 patients (1.54 %) identified with intraoperative SSEP signal changes (two patients excluded due to insufficient follow-up data (n = 35; Group A = 19, Group B = 16). Patients followed for at least 24 months. At latest follow-up, 10 patients (62.5 %) in Group B either returned to baseline or improved; 6 patients continued to have some neurological deficit. Of significance, Group B patients were younger (p=0.04) and use of an interbody was higher (p = 0.01). No significant differences found for gender, body mass index, preoperative mean arterial pressure, CCI, number of levels decompressed, or estimated blood loss. We observed a positive predictive value of 45.7 % with intraoperative SSEP changes.
Conclusion
SSEP changes during lumbar spine surgery that are irreversible portend a higher rate of neurological injury. We observed reliable motor recovery in patients who experienced postoperative neurological deficits in an average of 3.9 months. Secondly, use of an interbody was associated with poorer recovery rates.
{"title":"Rate and prediction of outcomes after neuromonitoring signal changes in somatosensory evoked potentials in lumbar spine surgery: A 10-year experience","authors":"Nikhil Adapa , Andrew J. Rosso , Sandra M. Catanzaro , Emma C. Smith , W. Jacob Lavelle , Elizabeth A. Demers Lavelle , Richard A. Tallarico , Willam F. Lavelle","doi":"10.1016/j.wnsx.2025.100546","DOIUrl":"10.1016/j.wnsx.2025.100546","url":null,"abstract":"<div><h3>Background</h3><div>Data: Intraoperative neuromonitoring changes of somatosensory evoked potentials (SSEPs) may portend postoperative neurological deficits. We assessed the predictive power of SSEP changes during lumbar spinal surgery for postoperative neurological deficits and recovery rates.</div></div><div><h3>Methods</h3><div>In a retrospective multi-surgeon review of neuromonitoring logs, we identified all lumbar spine surgery patients (2011–2021) from our institution. We collected demographic, clinical, surgical and follow-up data on only subjects with intraoperative SSEP changes categorizing them into Group A (intraoperative SSEP changes without postoperative neurological deficits) and Group B (intraoperative SSEP changes with postoperative neurological deficits) for statistical analysis.</div></div><div><h3>Results</h3><div>2398 subjects underwent lumbar spine surgery. 37 patients (1.54 %) identified with intraoperative SSEP signal changes (two patients excluded due to insufficient follow-up data (<em>n</em> = 35; Group <em>A</em> = 19, Group <em>B</em> = 16). Patients followed for at least 24 months. At latest follow-up, 10 patients (62.5 %) in Group B either returned to baseline or improved; 6 patients continued to have some neurological deficit. Of significance, Group B patients were younger (<em>p=</em>0.04) and use of an interbody was higher (<em>p</em> = 0.01). No significant differences found for gender, body mass index, preoperative mean arterial pressure, CCI, number of levels decompressed, or estimated blood loss. We observed a positive predictive value of 45.7 % with intraoperative SSEP changes.</div></div><div><h3>Conclusion</h3><div>SSEP changes during lumbar spine surgery that are irreversible portend a higher rate of neurological injury. We observed reliable motor recovery in patients who experienced postoperative neurological deficits in an average of 3.9 months. Secondly, use of an interbody was associated with poorer recovery rates.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100546"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.wnsx.2025.100542
Octavian Mihai Sirbu , Ioana Pricopi , Mathieu Lozouet , Elisabeth Garrido , Marian Mitrica , Stephane Derrey
This retrospective study evaluates prognostic factors in patients with penetrating traumatic brain injuries (pTBI) caused by gunshot wounds to the head, with a focus on a civilian cohort predominantly composed of self-inflicted injuries. The primary goal was to externally validate the SPIN score, a prognostic model developed for predicting survival after acute penetrating brain trauma. The analysis included 57 patients admitted over a 10-year period in a tertiary neurosurgical center. Most were middle-aged males, and over 90 % of injuries were self-inflicted.
Results confirmed that the full SPIN score had good predictive value for survival, with an AUC of 0.895 (CI: 0.817–0.974, p < 0.001). Among all variables, the Glasgow Coma Scale (GCS) at admission remained the most consistent independent predictor of unfavorable outcome. Neither midline shift nor chronic alcohol use reached statistical significance in multivariate analysis. Seasonal variation showed a higher number of self-inflicted injuries during winter, though this was not statistically significant.
The study confirms the utility of the SPIN score in civilian settings and emphasizes the need for individualized triage tools that account for the high lethality and unique clinical features of self-inflicted pTBI. Additionally, it advocates for caution in decision-making and highlights the limitations of relying solely on simplified scoring systems or outdated military-derived guidelines. Overall, the results support the SPIN score as a valuable framework for early prognostic assessment in neurotrauma, with potential implications for surgical planning, resource allocation, and family counseling.
本回顾性研究评估了头部枪伤引起的穿透性创伤性脑损伤（pTBI）患者的预后因素，重点研究了主要由自我伤害组成的平民队列。主要目的是从外部验证SPIN评分，这是一种用于预测急性穿透性脑外伤后生存的预后模型。该分析包括在三级神经外科中心10年期间入院的57例患者。大多数是中年男性，超过90%的受伤是自己造成的。结果证实，全SPIN评分对生存有很好的预测价值，AUC为0.895 （CI: 0.817-0.974, p < 0.001）。在所有变量中，入院时的格拉斯哥昏迷量表（GCS）仍然是最一致的不良结果的独立预测因子。在多变量分析中，中线移位和慢性酒精使用均未达到统计学意义。季节变化表明，冬季自伤人数较多，尽管这在统计上并不显著。该研究证实了SPIN评分在民用环境中的效用，并强调需要个性化的分类工具，以解释自我造成的pTBI的高致死率和独特的临床特征。此外，它提倡谨慎决策，并强调仅仅依赖简化的评分系统或过时的军事指南的局限性。总的来说，结果支持SPIN评分作为神经创伤早期预后评估的一个有价值的框架，对手术计划、资源分配和家庭咨询具有潜在的意义。
{"title":"Prognostic factors and SPIN score validation in civilian self-inflicted gunshot penetrating brain injuries","authors":"Octavian Mihai Sirbu , Ioana Pricopi , Mathieu Lozouet , Elisabeth Garrido , Marian Mitrica , Stephane Derrey","doi":"10.1016/j.wnsx.2025.100542","DOIUrl":"10.1016/j.wnsx.2025.100542","url":null,"abstract":"<div><div>This retrospective study evaluates prognostic factors in patients with penetrating traumatic brain injuries (pTBI) caused by gunshot wounds to the head, with a focus on a civilian cohort predominantly composed of self-inflicted injuries. The primary goal was to externally validate the SPIN score, a prognostic model developed for predicting survival after acute penetrating brain trauma. The analysis included 57 patients admitted over a 10-year period in a tertiary neurosurgical center. Most were middle-aged males, and over 90 % of injuries were self-inflicted.</div><div>Results confirmed that the full SPIN score had good predictive value for survival, with an AUC of 0.895 (CI: 0.817–0.974, <em>p</em> < 0.001). Among all variables, the Glasgow Coma Scale (GCS) at admission remained the most consistent independent predictor of unfavorable outcome. Neither midline shift nor chronic alcohol use reached statistical significance in multivariate analysis. Seasonal variation showed a higher number of self-inflicted injuries during winter, though this was not statistically significant.</div><div>The study confirms the utility of the SPIN score in civilian settings and emphasizes the need for individualized triage tools that account for the high lethality and unique clinical features of self-inflicted pTBI. Additionally, it advocates for caution in decision-making and highlights the limitations of relying solely on simplified scoring systems or outdated military-derived guidelines. Overall, the results support the SPIN score as a valuable framework for early prognostic assessment in neurotrauma, with potential implications for surgical planning, resource allocation, and family counseling.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100542"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.wnsx.2025.100528
Ahmed M. Assar , Seif Tarek El-Swaify , Mohamed A. Bashir , Ahmed Reda , Yasser O. Riyad
Arachnoid cysts (ACs) are identified in 1–2 % of the population through intracranial imaging. A possible complication of arachnoid cysts (ACs) is their rupture, which can lead to the development of a subdural hygroma (SDG). Currently, there is no consensus on management strategies for these patients. We present a comprehensive literature review of this topic. Our bibliographic database search (PubMed) identified 55 studies published between 1983 and 2023, encompassing data on 148 patients. The mean age was 12.3 years. Most patients were male (76.5 %). 71 patients had a history of trauma. The middle cranial fossa was the most common site for ACs (n = 146), with 52.7 % occurring on the left side. According to Galassi classification, 35.6 % (n = 52) were type 2 cysts. Most authors opted for operative management of symptomatic cases, typically involving hygroma evacuation and cyst fenestration into basal cisterns. Our review of the literature revealed that, the most prevalent surgical approach was craniotomy with microscopic cyst fenestration, which was performed in 29 cases. Conversely, burr holes with endoscopic cyst fenestration were utilized in 20 cases. A conservative follow-up strategy was adopted in 18 cases. The mean post-operative follow-up period was 2.5 years. Ruptured ACs complicated by SDGs are infrequently encountered in neurosurgical practice, complicating the development of standardized treatment protocols. Thus, management should be individualized.
{"title":"Management strategies for arachnoid cysts presenting with subdural hygromas: Literature review","authors":"Ahmed M. Assar , Seif Tarek El-Swaify , Mohamed A. Bashir , Ahmed Reda , Yasser O. Riyad","doi":"10.1016/j.wnsx.2025.100528","DOIUrl":"10.1016/j.wnsx.2025.100528","url":null,"abstract":"<div><div>Arachnoid cysts (ACs) are identified in 1–2 % of the population through intracranial imaging. A possible complication of arachnoid cysts (ACs) is their rupture, which can lead to the development of a subdural hygroma (SDG). Currently, there is no consensus on management strategies for these patients. We present a comprehensive literature review of this topic. Our bibliographic database search (PubMed) identified 55 studies published between 1983 and 2023, encompassing data on 148 patients. The mean age was 12.3 years. Most patients were male (76.5 %). 71 patients had a history of trauma. The middle cranial fossa was the most common site for ACs (<em>n</em> = 146), with 52.7 % occurring on the left side. According to Galassi classification, 35.6 % (<em>n</em> = 52) were type 2 cysts. Most authors opted for operative management of symptomatic cases, typically involving hygroma evacuation and cyst fenestration into basal cisterns. Our review of the literature revealed that, the most prevalent surgical approach was craniotomy with microscopic cyst fenestration, which was performed in 29 cases. Conversely, burr holes with endoscopic cyst fenestration were utilized in 20 cases. A conservative follow-up strategy was adopted in 18 cases. The mean post-operative follow-up period was 2.5 years. Ruptured ACs complicated by SDGs are infrequently encountered in neurosurgical practice, complicating the development of standardized treatment protocols. Thus, management should be individualized.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100528"},"PeriodicalIF":2.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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